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General NPI Number Information
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NPI Number | 1457039596
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Entity Type | Organization
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Legal Business Name | WINGSPAN THERAPY, PLLC
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 5117B MAIN ST STE 12
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-4602
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Country | US
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Telephone | 630-320-6981
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Fax | 312-748-4245
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Provider Business Mailing Address
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Address Line | 155 N HUDSON ST
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City | WESTMONT
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State | IL
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Zip | 60559-1625
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Country | US
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Telephone | 630-320-6981
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEREDITH ENTLER
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Credential | LCPC
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Telephone | 630-320-6981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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